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Commercial Quote

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Commercial Quote Form

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What types of business insurance do you need?

General Liability and Commercial Property

Workers Compensation

Commercial Auto

Can you tell us about your company?

Company Name

Company Name

DBA (If Applicable)

DBA (If Applicable)

FEIN # (If Applicable)

FEIN # (If Applicable)

Organization Type

Founding Date

Founding Date

Is this a subsidary?

Business has a trust?

Has other subsidiaries?

Phone

Phone

Primary Business Address

Primary Business Address

Garage Address

Garage Address

Garage Zip Code

Garage Zip Code

Mailing Address (If different than Garage Address)

Mailing Address

Mailing Address

Mailing Zip Code

Mailing Zip Code

What is your annual payroll?

What is your annual payroll?

What is your annual revenue?

What is your annual revenue?

How many FULL TIME empolyees does your business have?

How many FULL TIME empolyees does your business have?

How many PART TIME employees does your business have?

How many PART TIME employees does your business have?

Type of Business

Description of Buisness

Description of Buisness

Primary Contact

Primary Contact Name

Primary Contact Name

Primary Contact Phone Number

Primary Contact Phone Number

Primary Contact Email

Primary Contact Email

Please tell us about the vehicles used in your business

How are vehicles used in business?

How are vehicles used in business?

Individual Name or Business Name

Individual Name or Business Name

List all owners of vehicle (Include Name, Phone Number and Email)

List all owners of vehicle (Include Name, Phone Number and Email)

Do any of the following apply to your business?

No

Draws plans, Designs, or Specifications

Using or Storing Explosives

Excavation, Tunneling or Earth Moving

Lease Equipment to Others

Can you tell us about your prior insurance?

Current Carrier

Current Carrier

Expiration Date

Expiration Date

Effective Date

Effective Date

Number of Months

Number of Months

Annualized Premium

Annualized Premium

Notes

Notes

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